Childhood Insomnia

Roughly a quarter of children complain of bedtime struggles and night awakenings. Childhood sleep problems may arise for a variety of reasons such as medical illness, irregular schedules, and difficulties with limit-setting. If left unresolved, the impact to the child, caregiver, and the family can be quite large. Sleep disturbances and/or insufficient sleep as a result of these sleep disturbances negatively impact children in various areas such as:

A child with insomnia can cause family members to lose sleep and disrupt family functioning.

Three common diagnoses for the Behavioral Insomnias of Childhood include:

Sleep-Onset Association Type involves children who won’t sleep because they need to be with a specific item or person to fall asleep or get back to sleep after awakening.

Limit-Setting Type describes children who refuse or stall bedtime. They may scream and cry or ask for hugs kisses or even drinks of water to avoid sleeping. Parents who struggle enforcing limits such as a scheduled bedtime may encourage this behavior.

Combined Type, as the name indicates, is a combination of both sleep-onset association and limit-setting symptoms.

Behavioral interventions are the standard approach for treatment of behavioral insomnia of childhood. Caregivers play a key role in establishing and maintaining children’s sleep. A behavioral sleep medicine specialist works closely with both the parent and child to resolve the sleep problem.

Several approaches use extinction, a technique that involves placing a child in bed at a regular time and leaving them there until they can fall asleep without help. The goal is stop rewarding the child with attention for avoiding sleep. Positive routines and bedtime fading are two additional approaches. Positive routines involve positive and rewarding bedtime interactions with the caregiver. Bedtime fading involves delaying the child’s bedtime to match their natural sleep onset time and slowly advancing the bedtime to allow for an age-appropriate total sleep time. Positive routines help the child to establish cues for sleep onset, while bedtime fading increases the likelihood the child will experience quick sleep onset when placed in bed. Typically improvements are noticed within 1-2 weeks and treatment generally lasts 2-6 sessions.